Women's Health

Abdominal Aortic Aneurysm a Concern for Women Smokers

Women who smoke are eight times more likely than nonsmokers to suffer a potentially fatal rupture of the body's largest artery, or require surgery to repair the weakening that can cause such a rupture.

That is the conclusion of the latest data from the Women's Health Initiative, the landmark trial most noted for the 2002 finding that hormone replacement therapy increases the risk of heart problems.

The new study's findings, published in the British Medical Journal, come from analysis led by Dr. Frank Lederle at the University of Minnesota.

"My particular interest is abdominal aortic aneurysm," says Dr. Lederle. "Most previous studies of it have been in men, so this is an opportunity to look at a very large study in women."

Blood Vessel Weakens or Balloons

The aorta is the main artery carrying blood from the heart. An aneurysm is a weakening or ballooning of the blood vessel, a process that can take years to develop, often without symptoms.

Some 15,000 Americans die each year when an abdominal aortic aneurysm ruptures; 40 percent of them are women.

The link between smoking and aneurysm was anticipated.

"No one would have expected otherwise," he says. "There is a very strong association in men as well."

Even women who gave up smoking had a fourfold higher incidence of rupture than women who never smoked.

What really interested Dr. Lederle was the finding that women with diabetes were less likely to have a rupture or require surgery. The reason remains unclear, he says.

"Diabetes makes the arteries stiff, so that might be protective," says Dr. Lederle. "But other studies show that stiff arteries lead to abdominal aortic aneurysm. What we are going to need is a complete biochemical explanation."

The study also found that hormone replacement therapy reduced the risk of abdominal aortic aneurysm.

"We expected to see it, but the relationship was surprisingly strong," explains Dr. Lederle. "We certainly are not going to recommend that it [hormone replacement therapy] be used for that purpose."

The various findings "are of interest to guide future research," he adds. "We would hope to develop a specific test for this condition."

Screening Helps Find the Problem

Dr. David G. Neschis, at the University of Maryland, says the biggest impact of the new study "will be to raise awareness about the importance of abdominal aortic aneurysm in women. The focus has been on men, and so, it is not screened for as frequently in women.

"There are a huge number of undiagnosed aneurysms in women," adds Dr. Neschis. "Most now are identified as incidental findings, when a woman has a CT scan of the gall bladder or magnetic resonance imaging for back trouble. Perhaps women should be screened more aggressively."

Screening is especially advisable for women who smoke, have high blood pressure, or a family history of the condition, says Dr. Neschis. Age is also a factor, because, "if you have it, it grows slowly over time."

Always consult your physician for more information.

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January 2009

Abdominal Aortic Aneurysm Defined

An abdominal aortic aneurysm, also called AAA or triple A, is a bulging, weakened area in the wall of the aorta (the largest artery in the body), resulting in an abnormal widening or ballooning greater than 50 percent of the normal diameter (width).

The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys.

An abdominal aneurysm located below the kidneys is called an infrarenal aneurysm. An aneurysm can be characterized by its location, shape, and cause.

The shape of an aneurysm is described as being fusiform or saccular which helps to identify a true aneurysm. The more common fusiform-shaped aneurysm bulges or balloons out on all sides of the aorta.

The aorta is under constant pressure as blood is ejected from the heart. With each heart beat, the walls of the aorta distend (expand) and then recoil (spring back), exerting continual pressure or stress on the already weakened aneurysm wall.

Therefore, there is a potential for rupture (bursting) or dissection (separation of the layers of the aortic wall) of the aorta, which may cause life-threatening hemorrhage (uncontrolled bleeding) and, potentially, death. The larger the aneurysm becomes, the greater the risk of rupture.

Because an aneurysm may continue to increase in size, along with progressive weakening of the artery wall, surgical intervention may be needed. Preventing rupture of an aneurysm is one of the goals of therapy.

About three of every four abdominal aortic aneurysms are asymptomatic and may be found upon routine physical examination by the discovery of a pulsating mass in the abdomen.

An aneurysm may also be discovered by x-ray, computed tomography scan (CT scan), or magnetic resonance imaging (MRI) that is being done for other conditions. Since abdominal aneurysm may be present without symptoms, it is referred to as the “silent killer” because it may rupture before being diagnosed.

Pain is the most common symptom of an abdominal aortic aneurysm. The pain associated with an abdominal aortic aneurysm may be located in the abdomen, chest, lower back, or groin area. The pain may be severe or dull. The occurrence of pain is often associated with the imminent (about to happen) rupture of the aneurysm.

Acute, sudden onset of severe pain in the back and/or abdomen may represent rupture and is a life threatening medical emergency.

The symptoms of an abdominal aortic aneurysm may resemble other medical conditions or problems. Always consult your physician for more information